Out-of-pocket health spending between low-and higher-income populations: who is at risk of having high expenses and high burdens?

Med Care. 2006 Mar;44(3):200-9. doi: 10.1097/01.mlr.0000199692.78295.7c.


Objective: We studied the effects of health insurance, health care needs, and demographic and area characteristics on out-of-pocket health care spending for low and higher income insured populations.

Materials and methods: We used the 2002 National Survey of America's Families to analyze out-of-pocket health spending. People were classified into 3 levels of expenses based on their out-of-pocket health care spending and 3 levels of financial burden based on spending as a share of family income. We used a multinomial logit model to estimate the effect of insurance status and other factors on expense and burden levels.

Results: Public insurance appears to offer the best financial protection from high out-of-pocket expenses and financial burden for those who are eligible. Families with private nongroup coverage have the highest odds of being in the high-expense and high-burden categories for all incomes. For higher-income families, having a family member in fair or poor health is a significant risk factor for high out-of-pocket expenses and financial burden. Having higher penetration of health maintenance organizations in an area appears to lower the odds of being in the high-burden category for all families.

Conclusions: Health insurance may not prevent people from having high health care spending. Low-income people with serious health needs appear to be financially constrained and spend less on health care relative to higher-income people, and the presence of health maintenance organizations may help reduce out-of-pocket health care spending.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cost of Illness
  • Data Collection
  • Demography
  • Financing, Personal / economics*
  • Health Expenditures*
  • Health Services Needs and Demand
  • Humans
  • Risk Assessment
  • Social Class*
  • United States